Daniel C. Park DDS Inc

Primary specialty

DentistTaxonomy code 122300000X

License

47983 Issued in CA

Legal business name

DANIEL C. PARK DDS INC

Practice address

1202 Beaumont Ave
Beaumont, CA 92223-1506

Phone

(951) 845-2661

Fax

(888) 462-1262

NPI assigned

Dec 11, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Daniel Park, DDSNPI 1598803116

Title

President

Phone

(951) 845-2661

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel C Park, D.D.S.

  • General Practice Dentistry
  • Beaumont, CA
  • NPI 1598803116
  NPD (past) Authorized official
• Keiko Davisson, DDS

  • Dentist
  • Beaumont, CA
  • NPI 1295499671
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449792000000",
    "number": "1073988341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 BEAUMONT AVE",
            "city": "BEAUMONT",
            "state": "CA",
            "postal_code": "922231506",
            "telephone_number": "951-845-2661",
            "fax_number": "888-462-1262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 BEAUMONT AVE",
            "city": "BEAUMONT",
            "state": "CA",
            "postal_code": "922231506",
            "telephone_number": "951-845-2661",
            "fax_number": "888-462-1262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL C. PARK DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-11",
        "last_updated": "2015-12-11",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-845-2661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "47983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1598803116",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• David Kleis II, LLC
• David Kleis, Inc.
• Brittany Davila
• Keiko Davisson, DDS

• Dentist in Beaumont, CA
• Providers in Beaumont, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.